I sometimes imagine how I might be working in the future. I suspect there will be a convergence of the EMR with social types of communication.
It might go something like this:
I see a patient and record basic information to a tablet at the bedside. I complete my record at my workstation which syncs with my tablet. At my workstation I have a large flat screen monitor with my EMR occupying the left side. On the right is a communication portal that consists of a real time stream of direct professional communication with my local pediatricians. Think Twitter with encrypted, HIPAA compliant dialog.
So I’m at my workstation completing my impression on my last patient when a message pops up from one of the pediatricians at Texas Children’s Practice Associates. He sees that I’m live at my desk and wonders if I have a minute to discuss a case via telechat.
Caleb Jones (fictional), a boy with ulcerative colitis, is in his office with mild cramping and occasional blood-streaked stools. He asks what I recommend. His name is tagged which immediately brings his chart to the left side of my screen. I see that his Colazal dose is low relative to his recent growth. I recommend some blood work and a bump in his Colazal dose. We arrange follow up in 4 weeks.
The brief exchange automatically becomes part of the record.
The system recognizes that I’m discussing ulcerative colitis and Colazal. In a panel on the right lower portion of my screen appear 4 recent publications on 5-ASA use. One recent study catches my eye that suggests high dose 5-ASA is equally as effective as steroids in mild UC. I select the study and it’s immediately available on my desktop.
In the upper right hand of my screen is a panel carrying a real time stream for pediatric gastroenterologists worldwide. It’s a place for the presentation and discussion of tough pediatric GI cases. Cases are tagged so that I can follow discussions centered on inflammatory bowel disease, for example.
On the lower left part of the screen I can passively monitor the dialog happening between incoming patient messages and our triage nurse. Serious issues and things that she doesn’t think she can handle are flagged to me so that I can review the thread or recorded tele-exchange. I can then communicate directly back with the nurse or patient depending on the nature of the problem. This too is linked to the child’s record.
How cool would that be? The vision of a dashboard has been the subject of dialog by others long before this post. Jay Parkinson has done something like this over at Hello Health but it hasn’t been tailored to the masses.
What would you want on your digital dashboard?
Image via Web Icon Set.
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Very cool but the reality of the situation is tha our current human technological capacity cannot integrate the complex work flow of clinical medicine anywhere near what u envision without serious glitches and loss of productivity
Maybe in a couple of decades we’ll be closer BUT:
Will technology librate the clinician or enslave them to rigidly-dictated and tracted protocol?
The answer is the latter. The hype about technology is not about making things more pleasant for docs or patients but to control their behavior in order to control costs. Period.
I think my scenario is much closer than 20 years but perhaps your right. And while technology has the potential to enslave us, it has the potential to liberate us. If you haven’t already, read Jaron Lanier’s You Are Not a Gadget. It’s an interesting read and probably right up your alley.
I’m not even a doctor (though my mom wishes I was) yet I was literally riveted to the screen, tingling with excitement, and envisioning each step of the scenario that you painted.
Just a dream?
In response to “Reality” (above), I don’t think that such things are as much as 20 years away. Just look at where we were 20 years ago, and then accelerate that growth curve according to Moore’s law … “The number of transistors that can be placed inexpensively on an integrated circuit has doubled approximately every two years. The trend has continued for more than half a century and is not expected to stop until 2015 or later.”
And while I do think that one of the goals of such implemented technology will be to control costs (accurately pointed out by “Reality”), I would hope that by the time such technology was available that we would have also realized that preventive care, and well coordinated care are the best path to that very goal.
I concur with “Reality” on the issue of productivity as we know it. It’s a current concern that plays itself out with poorly planned EHR implementations right now. But I also believe that these things will be resolved over time. And 20 years from now we’ll be looking back at how “unproductive” our silly, fragmented way of doing things used to be.
Lastly, I, personally, don’t want to put the brakes on such a vision. After all, isn’t it up to the present generation to strategize and invest in the future … whether or not we’re there to enjoy its ultimate benefits?
Wow. I’ll have to do more of this! Actually I could have made this 5000 words with more tangents. And truthfully, I believe this is very close. Thanks for chiming in and offering your insight.
Dr V,
I am a technology professional that has worked on a variety of technology projects for large and small healthcare organizations and your vision is dead on. While Reality points out a number of issues, especially around cost control, the truth is that the internet and social networking are perfect ways to enhance the patient experience while providing a great platform for healthcare professionals to take part in the emerging science of social learning.
When the internet emerged as a viable platform for retail organizations in the mid 90′s, vast issues of integration with product, supply chain, billing, customer service and returns were very daunting. Within 5 or 6 years most of these issues were largely solved due to the visionary companies and entrepreneurs that started a wide array of technologies to solve the issues.
I predict that the same will be true of healthcare.
I have started a company that focuses on providing exactly what you are talking about and interest has been very good.
Let the future begin!
Dr. V.
Thanks for taking the time to paint such a clear pic of your ideal patient/doctor/practice experience. It’s this kind of visioning that helps to create the future.
For full disclosure, I too work in the healthcare IT field, but not in the areas that you talk about. I think your idea of the dashboard is pretty cool, though I wonder how patients will take to doctors tapping away on a tablet while in the exam rooms. I guess its just something we’ll all become accustomed to.
Just a comment about the social aspect of the vision. Although I believe that there will definitely be companies that try to put everything together into one single package, I think that practices will be “forced” to use the tools that people already use at home: Twitter, Facebook, etc. Why? Because anyone <30 are already using these tools and if their current providers don't want to engage with them using these tools then they can easily find ones that do. If you do a search today on Twitter or FB you'll find that there are already conversations about people's personal health. HIPAA be damned. People want to connect and these tools already provide a rich platform upon which to do it. No need to create a proprietary one.
I am very excited to have stumbled across your blog, and especially this post. I’m a physician working in clinical informatics and have been envisioning a similar scenario to what you have drawn up. It’s great to know that there are others, like you, thinking the same way.
I agree with you in wishing that the current generation of physician-physician communications tools were closer to a real-time stream rather than something like Doximity has presented. The most important medical decisions are often made in the all-to0-rare times that multiple specialties and disciplines sit down and discuss a case together, and we need to have electronic tools to support and encourage this behavior. Without them, we’ll be stuck with the current method of reading each other’s daily consult notes and perhaps paging back and forth with a quick phone call in the middle.
We also need our clinical systems to start learning how to present us with the right information about our patients at the right time. If Google can get Priority Inbox to filter out what needs to be seen now and what can be seen later, we can get there for medicine too.
I look forward to following your blog.
Quite interesting! Yet replicating the actual doctor-patient contact remains elusive! However, technology will no doubt change things in due time
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